I walked into a room and positioned myself toward the head of the bed while the patient sat up. I was reviewing seated LE exercises and safety with the patient when his spouse walked in. She stood by the foot of the bed and began to question both myself and the patient in regard to being discharged. According to our therapy department, the patient was safe to go home and had achieved 90% of his goals. We were working toward achieving the last 10% of the goals when the spouse didn't think a discharge was a good idea.
The patient and wife began a slight disagreement about whether he was safe to go home. I tried to blend into the wall as best I could and even tried to make a small joke about the situation that failed miserably. My only escape was to either crawl across the patient's bed or push past the patient's wife while she was getting more and more upset with her husband. From experience, I know you do not try to walk away when a patient's spouse is in loud disagreement with a decision.
I was mentally preparing myself for the tuck and roll across the bed, figuring I could land on my feet and make a dash for the door before anyone knew what was happening. Fortunately the patient recognized my dilemma and stood up to guide his wife across the room while she was berating his decision to leave. He was a very brave man.
As I left the room, they were still arguing so I closed the door slightly so the noise would not carry out into the hallway. I walked toward the therapy gym and realized I am not a good mediator when couples have disagreements about whether to go home or stay longer. I can offer information about the patient's progression in therapy but the ultimate decision to go home lands in the patient's court provided he can make that decision with clarity. I often educate patients in regard to the reality of going home but they have to decide on their own based on information given to them. I did learn a very valuable lesson during the argument between the patient and his spouse; never get stuck in the corner of a patient's room without an escape route to the door.